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Understaffing as a Two‐Dimensional Phenomenon: A Cross‐Sectional Study of Hospital Nurses' Manpower and Expertise Understaffing

ABSTRACT

Aim(s)

To examine whether manpower and expertise understaffing are distinct, and whether they relate similarly to nursing stressors, burnout, job satisfaction and intentions to turnover.

Design

A cross-sectional survey of hospital nurses nested within units was used.

Methods

The sample included 402 nurses. Nurses provided ratings of the study's variables using validated self-report measures. The data were analysed both as multilevel and single-level data.

Results

Manpower and expertise understaffing contributed unique explained variance to all of the examined outcomes. Nurses within the same units experience different understaffing levels. Expertise understaffing emerged as a significantly stronger predictor than manpower understaffing for three of the six of the outcome variables (illegitimate tasks, job satisfaction and turnover intentions).

Conclusion

Manpower and expertise understaffing are distinct, and both are associated with nurse outcomes.

Reporting Method

We have adhered to the STROBE guideline for cross-sectional studies.

Implications for the Profession and/or Patient Care

Considering both manpower and expertise understaffing to maintain proper staffing levels in nursing units is crucial.

Patient or Public Contribution

A Director of Patient Care Services from the hospital where the study was conducted is a member of the research team. This member contributed to designing and conducting the study as well as interpreting the results.

Exploring the Healthcare Experiences and Preferences of LGBT+ People: An Online Asynchronous Focus Group Study

ABSTRACT

Aim

To explore experiences of LGBT+ individuals in accessing and receiving healthcare in Ireland, and to identify opportunities for more inclusive and equitable healthcare delivery.

Design

A descriptive qualitative study using asynchronous online focus groups.

Methods

Asynchronous online focus groups were conducted using the MURAL collaborative platform over a three-week period in 2023. Participants (n = 43) self-selected into one of three focus groups based on gender and sexual identity. Data were analysed using reflexive thematic analysis to generate key themes.

Results

Four themes were identified: (1) Culturally aware healthcare professionals; (2) Access and information; (3) Specialist versus universal services; and (4) Mental health support. Participants reported frequent experiences of misgendering, heteronormative assumptions, and provider inexperience. Geographic inequities, unclear referral pathways, and a lack of centralised, inclusive information were also key barriers. While specialist services were valued, participants advocated for a dual approach that integrates LGBT+ competence into all healthcare settings.

Conclusion

Despite legal and social progress, LGBT+ individuals in Ireland continue to encounter significant barriers to equitable healthcare. The findings highlight a need for improved cultural competence, better access to inclusive services, and systemic reform.

Implications for the Profession and/or Patient Care

Healthcare providers must receive comprehensive training in LGBT+ health to ensure respectful, appropriate, and inclusive care. Enhanced visibility of inclusive providers and improved service pathways are needed to address current inequities, particularly in mental health and gender-affirming care.

Impact

This study identifies key gaps in provider competence, service accessibility, and mental health provision. Findings will inform healthcare education, policy development, and service design to improve experiences and outcomes for LGBT+ individuals in both urban and rural contexts.

Reporting Method

This study adhered to the Standards for Reporting Qualitative Research (SRQR).

Patient or Public Contribution

No patient or public contribution was involved.

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